--- title: Bilateral Mandibulectomy - Fractures description: 10yr Shih Tzu's bilateral mandibulectomy due to multiple pathologic fractures secondary to periodontal disease. 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Most patients are more comfortable and can have a relatively cosmetic outcome. Almost all behave as if nothing is wrong within a few days to weeks after the procedure. Sometimes the mandibles are removed due to oral tumors. Other times, disease of the teeth progresses to mandibular fracture and the disease usually has insufficient bone quality preventing repair. This is a case of a bilateral mandibulectomy due to multiple pathologic fractures secondary to periodontal disease. ##### **Patient Information:** Coley Kay is a 10 year old spayed female Shih Tzu, owned by Judy Lukemyres. She presented after a fall. [Dr. Deb Conant](https://bebt.com/veterinarians/debra-conant-dvm) from [Bright Eyes and Bushy Tails in Iowa City, IA](https://bebt.com/) did a great job determining that Coley Kay had fractured her mandibles. Coley Kay was sent our way to determine if a repair or other treatment was needed. Below: Front and profile views of short mandibles on presentation                          ![jaw fx rostral MNectomy - BEFORE 4](https://tooth.vet/hs-fs/hubfs/Case%20Studies/November%202023/Before/jaw%20fx%20rostral%20MNectomy%20-%20BEFORE%204.jpg?width=250&height=333&name=jaw%20fx%20rostral%20MNectomy%20-%20BEFORE%204.jpg).   ![jaw fx rostral MNectomy - BEFORE 5](https://tooth.vet/hs-fs/hubfs/Case%20Studies/November%202023/Before/jaw%20fx%20rostral%20MNectomy%20-%20BEFORE%205.jpg?width=250&height=333&name=jaw%20fx%20rostral%20MNectomy%20-%20BEFORE%205.jpg) ##### Dental Exam Findings: Coley Kay is severely brachycephalic and already had an almost ‘flat face.’ The fractures were present at the mid to caudal mandible at each lower first molar. ##### Advanced Imaging: (Hover over image to read caption) - ![Thin mandibular bone](https://23427187.fs1.hubspotusercontent-na1.net/hub/23427187/hubfs/Case%20Studies/November%202023/During%20-%20Imaging/Thin%20mandibular%20bone.png?width=1200&length=1200&name=Thin%20mandibular%20bone.png) Thin mandibular bone - ![CT right side with right mandibular fracture](https://23427187.fs1.hubspotusercontent-na1.net/hub/23427187/hubfs/Case%20Studies/November%202023/During%20-%20Imaging/CT%20right%20side%20with%20right%20mandibular%20fracture.png?width=1200&length=1200&name=CT%20right%20side%20with%20right%20mandibular%20fracture.png) CT right side with right mandibular fracture - ![CT left side with left mandibular fracture](https://23427187.fs1.hubspotusercontent-na1.net/hub/23427187/hubfs/Case%20Studies/November%202023/During%20-%20Imaging/CT%20left%20side%20with%20left%20mandibular%20fracture.png?width=1200&length=1200&name=CT%20left%20side%20with%20left%20mandibular%20fracture.png) CT left side with left mandibular fracture ##### ![CT slice with insufficient bone to be able to repair](https://tooth.vet/hs-fs/hubfs/Case%20Studies/November%202023/During%20-%20Imaging/CT%20slice%20with%20insufficient%20bone%20to%20be%20able%20to%20repair.jpg?width=500&height=220&name=CT%20slice%20with%20insufficient%20bone%20to%20be%20able%20to%20repair.jpg) Above: CT slice with insufficient bone to be able to repair ##### **Procedures Performed:** Bilateral mandibulectomy through the fracture sites along with removal of the diseased teeth. Coley Kay presented with only 7 of the 42 teeth remaining. Four of those 7 teeth were the structural, important teeth, yet all 7 were diseased beyond repair. The upper canine had a communication between the nose and the mouth (oral nasal fistula). All teeth remaining were removed and the small thin mandible portions were removed from the fracture sites forward. A cosmetic closure while rebuilding the lip vestibule to aid in retaining saliva was performed. The tongue will hang out, but it had done so often prior to the fall. The oral nasal fistula site was closed by making a wide tension free flap with specialized surgical closure to aid in providing support for areas unsupported by bone. ##### Before SURGERY: (Hover over image to read caption) - ![maxilla to mandible relationship prior](https://23427187.fs1.hubspotusercontent-na1.net/hub/23427187/hubfs/Case%20Studies/November%202023/Before/maxilla%20to%20mandible%20relationship%20prior.png?width=1200&length=1200&name=maxilla%20to%20mandible%20relationship%20prior.png) Maxilla to mandible relationship prior - ![inital mandible length before surgery](https://23427187.fs1.hubspotusercontent-na1.net/hub/23427187/hubfs/Case%20Studies/November%202023/Before/inital%20mandible%20length%20before%20surgery.png?width=1200&length=1200&name=inital%20mandible%20length%20before%20surgery.png) Inital mandible length before surgery - ![intraoral overview before surgery](https://23427187.fs1.hubspotusercontent-na1.net/hub/23427187/hubfs/Case%20Studies/November%202023/Before/intraoral%20overview%20before%20surgery.png?width=1200&length=1200&name=intraoral%20overview%20before%20surgery.png) Intraoral overview before surgery ##### VIDEO: Demonstrates fracture site mobility before surgery ##### After SURGERY: (Hover over image to read caption) - ![reforming lip vestible after mandibulectomy.jpg](https://23427187.fs1.hubspotusercontent-na1.net/hub/23427187/hubfs/Case%20Studies/November%202023/After/reforming%20lip%20vestible%20after%20mandibulectomy.jpg.png?width=1200&length=1200&name=reforming%20lip%20vestible%20after%20mandibulectomy.jpg.png) Reforming lip vestible after - ![cosmetic closure after removal of most of mandibles.jpg](https://23427187.fs1.hubspotusercontent-na1.net/hub/23427187/hubfs/Case%20Studies/November%202023/After/cosmetic%20closure%20after%20removal%20of%20most%20of%20mandibles.jpg.png?width=1200&length=1200&name=cosmetic%20closure%20after%20removal%20of%20most%20of%20mandibles.jpg.png) Cosmetic closure after removal of most of mandibles - ![cosmetic closure after mandibulectomy.jpg](https://23427187.fs1.hubspotusercontent-na1.net/hub/23427187/hubfs/Case%20Studies/November%202023/After/cosmetic%20closure%20after%20mandibulectomy.jpg.png?width=1200&length=1200&name=cosmetic%20closure%20after%20mandibulectomy.jpg.png) Cosmetic closure after mandibulectomy - ![completed shortened mandibles](https://23427187.fs1.hubspotusercontent-na1.net/hub/23427187/hubfs/Case%20Studies/November%202023/After/completed%20shortened%20mandibles.jpg.png?width=1200&length=1200&name=completed%20shortened%20mandibles.jpg.png) Completed shortened mandibles - ![Looking good during recovery](https://23427187.fs1.hubspotusercontent-na1.net/hub/23427187/hubfs/Case%20Studies/November%202023/After/Looking%20good%20during%20recovery.png?width=1200&length=1200&name=Looking%20good%20during%20recovery.png) Looking good during recovery ##### Follow-Up Information: While the mandibles are now much shorter, they are approximately 1cm shorter than the maxilla allowing for function to remain and still have a relatively cosmetic outcome. Below: Coley Kay, thriving after a successful mandibulectomy. A happy and healthy transformation! ![Coley Kay - Post Surgery](https://tooth.vet/hs-fs/hubfs/Case%20Studies/November%202023/After/Coley%20Kay%20-%20Post%20Surgery.jpeg?width=500&height=480&name=Coley%20Kay%20-%20Post%20Surgery.jpeg) - [Tweet](https://twitter.com/share) [![Bilateral Rostral Mandibulectomy - Oral Mass](https://tooth.vet/hubfs/Case%20Studies/September%202023/CT%20RADS/2%20FIOT%20Rostral_MNectomy_Sep_2023_CT_03.png)](https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/sep-2023-bilateral-rostral-mandibulectomy-oral-mass) #### [Bilateral Rostral Mandibulectomy - Oral Mass](https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/sep-2023-bilateral-rostral-mandibulectomy-oral-mass) ![Picture of Jennifer Mathis, DVM, DAVDC, CVPP](https://tooth.vet/hs-fs/hubfs/Jennifer%20Mathis%20-%20CV,%20Bio,%20Headshot/Jennifer%20Mathis%20-%20500x500%20Headshot-2.png?width=30&name=Jennifer%20Mathis%20-%20500x500%20Headshot-2.png) [Jennifer Mathis, DVM, DAVDC, CVPP](https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/author/mathis) : Oct 3, 2023 2:02:08 PM Case Summary: Removing or shortening the mandibles can be helpful. Most patients are more comfortable and can have a relatively cosmetic outcome.... 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Most patients are more comfortable and can have a relatively cosmetic outcome. As... [veterinary dentistry](https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/tag/veterinary-dentistry) [surgical mandible removal](https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/tag/surgical-mandible-removal) [rostral mandibulectomy](https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/tag/rostral-mandibulectomy) [veterinary surgery](https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/tag/veterinary-surgery) [mandible removal](https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/tag/mandible-removal) [Dental Health Management](https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/tag/dental-health-management) [surgical techniques](https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/tag/surgical-techniques) [Read More](https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/august-2023-rostral-mandibulectomy-3yo-french-bulldog) [![Canine Chronic Ulcerative Stomatitis (CCUS)](https://tooth.vet/hubfs/Case%20Studies/Canine%20Chronic%20Ulcerative%20Stomatitis%20%28CCUS%29%20-%20February%202024/Canine%20Chronic%20Ulcerative%20Stomatitis%20%28CCUS%29-2.png)](https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/canine-chronic-ulcerative-stomatitis) #### [Canine Chronic Ulcerative Stomatitis (CCUS)](https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/canine-chronic-ulcerative-stomatitis) ![Picture of Jennifer Mathis, DVM, DAVDC, CVPP](https://tooth.vet/hs-fs/hubfs/Jennifer%20Mathis%20-%20CV,%20Bio,%20Headshot/Jennifer%20Mathis%20-%20500x500%20Headshot-2.png?width=30&name=Jennifer%20Mathis%20-%20500x500%20Headshot-2.png) [Jennifer Mathis, DVM, DAVDC, CVPP](https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/author/mathis) : May 1, 2024 12:00:00 AM Case Summary: Canine Chronic Ulcerative Stomatitis (CCUS) is characterized by painful ulcerative lesions in the mucosal epithelium, believed to... [veterinary dentistry](https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/tag/veterinary-dentistry) [veterinary surgery](https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/tag/veterinary-surgery) [Dental Health Management](https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/tag/dental-health-management) [surgical techniques](https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/tag/surgical-techniques) [periodontal disease](https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/tag/periodontal-disease) [Veterinary case study](https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/tag/veterinary-case-study) [Animal Dental Care](https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/tag/animal-dental-care) [Boxer Health](https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/tag/boxer-health) [Pet Oral Health](https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/tag/pet-oral-health) [canine chronic ulcerative stomatitis](https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/tag/canine-chronic-ulcerative-stomatitis) [CCUS Treatment](https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/tag/ccus-treatment) [extraction](https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/tag/extraction) [Read More](https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/canine-chronic-ulcerative-stomatitis) ##### Quick Links Quick Links - [Refer a Patient](https://tooth.vet/patient-referral) - [Schedule a Consultation - For Pet Owners](https://tooth.vet/pet-owners) - [Dental Education](https://tooth.vet/dental-education) [![Animal-Dentistrylogo-transparent](https://tooth.vet/hubfs/Logos%20(Animal%20Dentistry)/Animal-Dentistrylogo-transparent.png)](https://tooth.vet/about-us) © 2025 Animal Dentistry Referral Services [Facebook](https://www.facebook.com/FamilyPetNorwalk)[YouTube](https://www.youtube.com/@toothvetia) Return to top ```json { "@context" : "https://schema.org", "@type" : "BlogPosting", "author" : { "@type" : "Person", "name" : "Jennifer Mathis, DVM, DAVDC, CVPP", "url" : "https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/author/mathis" }, "dateModified" : "2023-12-12T17:42:28.101Z", "datePublished" : "2023-11-15T17:01:05.000Z", "headline" : "Bilateral Mandibulectomy - Fractures", "image" : [ "https://23427187.fs1.hubspotusercontent-na1.net/hubfs/23427187/Case%20Studies/November%202023/Bilateral%20Mandibulectomy%20Fractures.png" ], "mainEntityOfPage" : { "@id" : "https://tooth.vet/beneath-the-surface-animal-dentistry-referral-services-case-chronicles/oct-2023-bilateral-mandibulectomy-fractures", "@type" : "WebPage" }, "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject" }, "name" : "Animal Dentistry Referral Services" } } ```